Principles of treatment 2


Chair: Catherine Blake, Ireland
Catherine Blake, Ireland
Mirror therapy/ Virtual rehabilitation
Andreas Rothgangel, Netherlands
Phantom limb pain following amputation occurs in up to 70% of all patients and represents a major challenge in the rehabilitation of amputees. In recent years, the potential of non-pharmacological interventions such as mirror therapy has been explored in the treatment of phantom limb pain. In order to achieve sustainable effects through mirror therapy, patients usually have to train independently over a longer period of time. Digital health applications might be useful in the context of patient self-management to increase training intensity. As part of the Patient Centered Telerehabilitation (PACT) project, a clinical framework and a digital health application for mirror therapy were developed in co-creation with different stakeholders. The clinical effects and feasibility of these interventions were evaluated in a three-arm multicenter randomized controlled study. In this presentation, the results of the PACT project and the lessons learned from the different phases of the project will be presented.
Electromagnetic therapy in the rehabilitation process
Teresa Paolucci, Italy
BACKGROUND: There are several evidences on the effects of extremely low frequency magnetic fields on modulation of biological variables and on various aspects of human and animal behavior, in particular they have been shown to have analgesic and antinociceptive effects in several organisms.
OBJECTIVE: To test the effects of extremely low frequency magnetic fields in reducing pain in patients with fibromylgia (FM).
STUDY DESIGN: Randomized double-blind crossover study.
POPULATION: Eleven FM patients with a mean age of 52,36±4,99 years.
MATERIALS AND METHOD: Patients were randomized to receive either half an-hour session of extremely low frequency magnetic fields therapy (CMF-ORTHO®, frequency 50 Hz intensity 0,5 mT) or placebo, 3 times a week for 4 weeks. The primary outcome measure was the Visual Analogue Scale (VAS) for the assessment of pain generalized or localized to a single joint or district. Secondary outcome measures were: Fibromyalgia Impact Questionnaire (FIQ) for the evaluation of range of symptoms experienced by FM patients, functionality with ADLs and work difficulties; Fibromyalgia Assessment Status (FAS) for the assessment of fatigue, sleep disturbances and pain; Health Assessment Questionnaire (HAQ) for the evaluation of the ability in daily living-tasks. Each subject was evaluated before, at the end (T1), after 3 (T2) and 6 months (T3) from the conclusion of the treatment.
RESULTS: At the end of treatment patients experienced improvements in all outcome measures relatives to baseline values with a significant improvement only in VAS (p<0,05) and FIQ (p<0,01).
CONCLUSIONS: ELF-MF therapy is effective in reducing pain in FM patients at the end of treatment. It is also effective in improving stiffness, fatigue and ability in ADLs. Further evaluations are ongoing to demonstrate whether these positive results will be maintained even at follow-up.
Nocebo and placebo
Fabrizio Benedetti, Italy

Although placebos have long been considered a nuisance in clinical research, today they are an active and productive field of research and, because of the involvement of many mechanisms, the study of the placebo effect can actually be viewed as a melting pot of concepts and ideas for neuroscience. Indeed, there exists not a single but many placebo effects, with different mechanisms and in different systems, medical conditions, and therapeutic interventions. For example, brain mechanisms of expectation, anxiety, and reward are all involved, as well as a variety of learning phenomena, such as Pavlovian conditioning, cognitive and social learning. There is also some experimental evidence of different genetic variants in placebo responsiveness. The most productive models to better understand the neurobiology of the placebo effect are pain and Parkinson’s disease. In these medical conditions, the neural networks that are involved have been identified: that is, opioid, cannabinoid, cholecystokinin, cyclooxygenase, dopamine modulatory networks in pain and part of the basal ganglia circuitry in Parkinson’s disease. Overall, the main concept that is emerging today is that placebos and drugs share common mechanisms of action, which suggests a cognitive/affective interference with drug action. 


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